[ comparative analysis of effectiveness, tolorance and cost of second generation antidepressants in France]

ABSTRACT

While French authorities point to the need for rational prescribing, especially concerning psychotropic drugs, few data on the prescription of second-generation antidepressants [SGA] are synthesized for clinicians' use. Our objective is to carry out a comparative analysis of effectiveness and tolerability / acceptability of SGA. Considering the benefit/risk ratio and the cost [generic], the first-line treatment for a major depressive episode may be currently sertraline [50 mg / d]. It may however have more digestive side effects than other SSRIs [due to the serotonin action], which calls for caution while increasing doses. Fluoxetine seems relevant in treatment of negative symptoms of schizophrenia [20mg / d] and in bulimia [60 mg / d]. Fluvoxamine seems relevant in the case of sexual side effects with a previous SSRI, in treatment of anxiety disorders [it's affinity for sigma receptors may confer a specific action] and in psychotic depression. Mirtazapine may be a treatment of interest when a fast remission of depressive symptoms [especially insomnia] is warranted but its tolerance profile makes it difficult to use